November 6, 2009

Expert Calls for Health Reform to Eliminate Health Disparities

Denise Rodgers delivers the keynote address at UCSF's third annual health disparities research symposium on Oct. 23.

Born in 1913 in Baltimore, Maryland, Virginia Burrell has defied the odds of early death caused by the major risk factor of being black in America.

“As was often the case at the turn of the last century, many people in [her] family died prematurely,” said Burrell’s daughter, Denise Rodgers, MD, a national expert in health disparities.

Burrell’s sister Beatrice died from tuberculosis while still a teenager, her brother, Prine, also died at a young age from unknown causes, and her mother, Daisy, died in 1921 from diabetes when she was only eight years old, Rodgers said.

As the keynote speaker in UCSF’s third annual health disparities research symposium on Oct. 23, Rodgers shared her perspective “as an African American female physician who has spent a career caring for primarily minority underserved patients in academic settings.”

Rodgers is executive vice president of Academic and Clinical Affairs and a professor of Family Medicine at the University of Medicine and Dentistry in New Jersey. Her long career in medicine includes serving as residency director and chief of staff at San Francisco General Hospital as well as professor and vice chair in the Department of Family and Community Medicine at UCSF.

Most of her remarks focused on disparities in health status between African Americans and whites in the United States, although Rodgers recognizes that there are disparities in health status between other minority groups and whites as well.

Call for Universal Coverage

“I am an educator and senior academic administrator seeking to learn how we can train health professionals to do it better,” Rodgers said. “I want to learn how we translate research findings into actions that will help to eliminate health disparities.”

Rodgers said it is not enough to merely study health disparities, but called upon her colleagues at UCSF to help end the inequalities and disparities in health and health care.

“It goes without saying that the disproportionate number of blacks and Hispanics who lack adequate health insurance contributes to health care disparities,” she said. “Universal coverage is critically important but not adequate to solving the problem of health disparities. During this critical time in our nation’s history it is critically important that we all do our part in helping our elected leaders understand the importance of universal coverage with a public option until we can get to single payer.

“All of us interested in eliminating health disparities must be willing to move away from the comfortable walls of academia and speak our truths about the adverse health consequences of racism, sexism, homophobia, and poverty,” Rodgers continued. “We need to increase our discourse on social justice and continually call out what we know that doesn’t need to be studied.

“Poverty, homelessness, being uninsured, being poorly educated, and being discriminated against are all bad for your health. It takes more than an apple a day to fix these problems. It takes a small, or not-so- small group of highly committed people to believe that we can create a more equitable and just society who then insist that we do so. It means that when you report on the findings of your research on disparity that you also report on the adverse consequences of discrimination and poverty.”

Faculty, staff and students gathered in the Laurel Heights auditorium on Oct. 23 to hear UCSF researchers talk about their work in health disparities.

As the nation grapples with the global pandemic of the H1N1 flu virus and the initially slow distribution of vaccines to combat it, Rodgers said there is a potential for minority children to be hardest hit by the novel virus.

“I recently had a conversation with a pediatrician from one of our medical schools who told me that some of the preliminary data on deaths in children from H1N1 appears to show that black and Hispanic kids are more likely do be hospitalized and die than their white counterparts,” she said. “We will have to wait and see if this turns out to be true.

“Whether it is true or not however, the reality in the United States in 2009 is that it is completely conceivable to all of us in this room that it could turn out to be true. It is almost as if we have become accustomed to adding yet another disease process to the list of areas where we find health disparities when we look. Maybe we should stop looking until we figure out what to do to eliminate these disparities. In other words, let’s put fewer resources into further documentation of disparities and more resources into developing concrete interventions that will eliminate disparities.”

Barbara Gerbert, PhD, professor in the Division of Behavioral Sciences, Professionalism, and Ethics in the UCSF School of Dentistry, who helped organize the health disparities research symposium, took the advice to heart. “We had increased participation, continuing reports of rigorous, outstanding science by stellar UCSF scientists, opportunities for networking and building coalitions and Denise Rodger’s compelling keynote address calling us to action and activism,” said Gerbert.

“Looking toward next year’s symposium, I am heartened by our chancellor’s call to put patients first in our research and to disseminate and implement excellent health care based on our research. I encourage our network of disparities researchers to heed both Dr. Rodger’s and Chancellor Desmond-Hellmann’s call to action and activism to improve our patient’s health and eliminate health disparities in the very near term. Next year, we can improve the symposium by urging participants to report on their efforts to apply their research findings to enhancing health on a broad basis.”

Eliminating health disparities is part of the UCSF Strategic Plan, released in June 2007. The plan specifically states that the “University, committed to the mission of advancing health worldwide™, must be a force to eliminate the pervasive disparities in health and health care in the local and national environment that are based on race or ethnicity, socioeconomic status and other social vulnerabilities.”

A Personal History

In her passionate and powerful speech that sparked tears, laughter and a standing ovation in the audience, Rodgers told her mother’s story to illustrate that fact that health disparities existed then and persist today.

Denise Rodgers, the 2009 Robert H. Crede Visiting Professor in Primary Care, right, stands with her 96-year-old mother Virginia Burrell.

“Around the time of Virginia’s birth, the life expectancy at birth for a black woman was 33.5 years, compared to 48.7 years for a white woman,” Rodgers said. “The life expectancy at birth for a black man was 32.5 years, compared to 46.6 years for a white man.”

At age 16, Burrell graduated from the all-black Douglass High School, the same school that Thurgood Marshall, the former Supreme Court justice who successfully fought against segregation in the 1950’s, had graduated from a few years before.

Burrell subsequently entered the nursing program at Provident Hospital in Baltimore, “the only hospital for colored people at the time,” Rodgers explained. After working as a nurse for several years, she decided that she wanted to continue her education by getting a bachelor’s degree in nursing. Burrell applied to the University of Maryland and met its criteria for admission. However, because the University of Maryland was segregated at the time, the State of Maryland arranged for her to attend the School of Nursing at New York University (NYU), and the state paid her tuition. “This was a rare positive outcome of segregation,” Rodgers noted.

In 1940, the year she graduated from NYU’s nursing school, the white infant mortality rate was 43.2 per 1,000 births and the rate for all other races was 73.8 per 1,000 births – a rate that was 1.7 times greater than the white rate, Rodgers reported.

“The data presented with the story of Virginia Burrell reminds us that disparities in health care and health outcomes between blacks and whites have existed in this country since the beginning of the time of data collection,” she said. “I can also say with a fair amount of certainty that disparities also existed during the previous two centuries prior to 1900 given the adverse health consequences of slavery.

“As we have moved into the 21st Century, it must be noted that tremendous progress has been made in life expectancy for people of all races and ethnicities in the United States,” Rodgers continued. “However, I would be remiss if I didn’t remind us all that there are still parts of the world today where life expectancy at birth in 2009 is not significantly better that it was in the United States in 1900. As we become, by necessity, more global in our outlook it is insufficient for us be satisfied with progress in health status that is local to the United States alone.

“That said, it is important that we remain vigilant and prioritize solutions to our internal problems of inequity in health and health care since these disparities undermine our continued progress as a nation.”

Rodgers pointed out that progress is painstakingly slow. In 1985, the US government published the Report of the Secretary’s Task Force on the Health of Blacks and Other Minorities. This report brought the concept of excess deaths into common nomenclature, a precursor to the concept of disparities, Rodgers explained. The six causes of excess death identified in the report were: heart disease, cancer, infant mortality, homicide, infant mortality, and cirrhosis.

“Soon after the report was published HIV/AIDS was added as a seventh cause of excess death,” Rodgers said. “Disparities in death rates remain for all seven of these causes of death now nearly 25 years later.”

Rodgers acknowledged that minority groups must take personal responsibility for their own health and health care choosing to live a healthy lifestyle, seeking preventive care and learning to trust in health care providers. But gaining trust takes time, she said.

“As a health care professional and as a black woman I can tell you there is an enormous level of mistrust of the health care system in the black community in America,” Rodgers said. “Some of it undoubtedly stems from Tuskegee [experiments] and other research and clinical abuses that occurred in the past. Let’s remember that the Tuskegee study was supposed to last for six months. It lasted for 30 years! The study didn’t end until 1972, long after effective treatments for syphilis had been identified. The legacy of that study exists today and our behaviors as academicians and researchers have not always helped.”

Rodgers concluded that she hopes that the ambitions and audacity symbolized in the historic presidency of Barack Obama are realized and result in meaningful change in America.

“We can’t afford to let our dream explode. There are too many people counting on us to get this right. I have an 11-year-old daughter who is counting on us to get this right.”

Top two photos by David Hand

Call for Universal Coverage

A Personal History

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